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The Long-Term Effects of Bariatric Surgery for Type 2 Diabetes: Systematic Review and Meta-analysis of Randomized and Non-randomized Evidence

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Abstract

This study aims to assess the long-term effects of bariatric surgery on type 2 diabetic patients. We searched Cochrane Library, PubMed, and EMbase up to Dec 2013. Randomized controlled trials (RCTs) and cohort studies of bariatric surgery for diabetes patients that reported data with more than 2 years of follow-up were included. We used rigorous methods to screen studies for eligibility and collected data using standardized forms. Where applicable, we pooled data by meta-analyses. Twenty-six studies, including 2 RCTs and 24 cohort studies that enrolled 7883 patients, proved eligible. Despite the differences in the design, those studies consistently showed that bariatric surgery offered better treatment outcomes than non-surgical options. Pooling of cohort studies showed that BMI decreased by 13.4 kg/m2 (95 % confidence interval (CI), −17.7 to −9.1), fasting blood glucose by 59.7 mg/dl (95 % CI, −74.6 to −44.9), and glycated hemoglobin by 1.8 % (95 % CI, −2.4 to −1.3). Diabetes was improved or in remission in 89.2 % of patients, and 64.7 % of patients was in remission. Weight loss and diabetes remission were greatest in patients undergoing biliopancreatic diversion/duodenal switch, followed by gastric bypass, sleeve gastrectomy, and adjustable gastric banding. Bariatric surgery may achieve sustained weight loss, glucose control, and diabetes remission. Large randomized trials with long-term follow-up are warranted to demonstrate the effect on outcomes important to patients (e.g., cardiovascular events).

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References

  1. IDF diabetes atlas, 5th edition [Internet], International Diabetes Federation; 2013 [cited 2013 Dec]. Available from http://www.idf.org/sites/default/files/5EIDFAtlasPoster2012EN.pdf.

  2. Global guideline for type 2 diabetes [Internet], International Diabetes Federation; 2012 [cited 2013 Dec]. Available from http://www.idf.org/global-guideline-type-2-diabetes-2012.

  3. Picot J, Jones J, Colquitt JL, et al. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess. 2009;13(41):1–190. 215-357 PMID:19726018.

    Article  CAS  Google Scholar 

  4. Whitlock G, Lewington S, Sherliker P, et al. Body-mass index and cause-specific mortality in 900,000 adults: collaborative analysis of 57 prospective studies. Lancet. 2009;373(9669):1083–96. Epub 2009 Mar 18. PMID:19299006.

    Article  PubMed  Google Scholar 

  5. Mazzone T, Chait A, Plutzky J. Cardiovascular disease risk in type 2 diabetes mellitus: insight from mechanistic studies. Lancet. 2008;371(9626):1800–9. PMID:18502305.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Colberg SR, Sigal RJ, Fernhall B, et al. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care. 2010;33(12):2692–6. PMID:21115771.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Resnick HE, Foster GL, Beardsley J, Ratner RE. Achievement of American Diabetes Association clinical practice recommendations among U.S. adults with diabetes, 1999–2002: the National Health and Nutrition Examination Survey. Diabetes Care. 2006;29(3):531–7.

    Article  PubMed  Google Scholar 

  8. Bennett WL, Maruthur NM, Singh S, et al. Comparative effectiveness and safety of medications for type 2 diabetes: an update including new drugs and 2-drug combinations. Ann Intern Med. 2011;154(9):602–13. Epub 2011 Mar 14. PMID:21403054.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Cramer JA. A systematic review of adherence with medications for diabetes. Diabetes Care. 2004;27(5):1218–24. PMID:1511553.

    Article  PubMed  Google Scholar 

  10. Gloy VL, Briel M, Bhatt DL, et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ. 2013;347:f5934. PMID:24149519.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Ribaric G, Buchwald JN, McGlennon TW. Diabetes and weight in comparative studies of bariatric surgery vs conventional medical therapy: a systematic review and meta-analysis. Obes Surg. 2014;24(3):437–55. PMID:24374842.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. American Diabetes Association. Standards of medical care in diabetes--2013. Diabetes Care. 2013;36 Suppl 1:S11–66. PMID:23264422.

    Article  PubMed Central  Google Scholar 

  13. Dixon JB, Zimmet P, Alberti KG, et al. Bariatric surgery: an IDF statement for obese type 2 diabetes. Diabet Med. 2011;28(6):628–42. PMID: 21480973.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248–256.e5. PMID:19272486.

    Article  PubMed  Google Scholar 

  15. Maggard-Gibbons M, Maglione M, Livhits M, et al. Bariatric surgery for weight loss and glycemic control in nonmorbidly obese adults with diabetes: a systematic review. JAMA. 2013;309(21):2250–61. PMID:23736734.

    Article  CAS  PubMed  Google Scholar 

  16. Li Q, Chen L, Yang Z, et al. Metabolic effects of bariatric surgery in type 2 diabetic patients with body mass index <35 kg/m2. Diabetes Obes Metab. 2012;14(3):262–70. Epub 2011 Dec 27. PMID:22051116.

    Article  CAS  PubMed  Google Scholar 

  17. Wells GA, O’Connell D, Peterson J, et al. The Newcastle Ottawa Scale (NOS) for assessing the quality of non randomised studies in Meta analyses, 2011 [cited 2013 Dec]. Available from http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.

  18. Higgins JPT, Green S, eds. Cochrane handbook for systematic reviews of interventions version 5.1.0. The Cochrane Collaboration, 2011 [updated 2011 March, cited 2013 Dec]. available from http://www.cochrane-handbook.org.

  19. Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes—3-year outcomes. N Engl J Med. 2014;370(21):2002–13. Epub 2014 Mar 31. PMID: 24679060.

    Article  CAS  PubMed  Google Scholar 

  20. Lee WJ, Chong K, Lin YH, Wei JH, Chen SC. Laparoscopic sleeve gastrectomy versus single anastomosis (mini) gastric bypass for the treatment of type 2 diabetes mellitus 5-year results of a randomized trial and study of incretin effect. Obes Surg. 2014 Jun 26. Epub ahead of print. PMID: 24965545.

  21. Abbatini F, Rizzello M, Casella G, et al. Long-term effects of laparoscopic sleeve gastrectomy, gastric bypass, and adjustable gastric banding on type 2 diabetes. Surg Endosc. 2010;24(5):1005–10. Epub 2009 Oct 29. PMID:19866235.

    Article  CAS  PubMed  Google Scholar 

  22. Alexandrides TK, Skroubis G, Kalfarentzos F. Resolution of diabetes mellitus and metabolic syndrome following Roux-en-Y gastric bypass and a variant of biliopancreatic diversion in patients with morbid obesity. Obes Surg. 2007;17(2):176–84. PMID:17476868.

    Article  PubMed  Google Scholar 

  23. Brethauer SA, Aminian A, Romero-Talamás H, et al. Can diabetes be surgically cured? Long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes mellitus. Ann Surg. 2013;258(4):628–36. PMID:24018646.

    PubMed Central  PubMed  Google Scholar 

  24. Iaconelli A, Panunzi S, De Gaetano A, et al. Effects of bilio-pancreatic diversion on diabetic complications: a 10-year follow-up. Diabetes Care. 2011;34(3):561–7. Epub 2011 Jan 31. PMID:21282343.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Jimenez A, Casamitjana R, Flores L, et al. Long-term effects of sleeve gastrectomy and Roux-en-Y gastric bypass surgery on type 2 diabetes mellitus in morbidly obese subjects. Ann Surg. 2012;256(6):1023–9. PMID:22968072.

    Article  PubMed  Google Scholar 

  26. MacDonald KG, Long SD, Swanson MS, et al. The gastric bypass operation reduces the progression and mortality of non-insulin-dependent diabetes mellitus. J Gastrointest Surg. 1997;1(3):213–20. PMID:9834350.

    Article  PubMed  Google Scholar 

  27. Sjöström L, Peltonen M, Jacobson P, et al. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA. 2014;311(22):2297–304. PMID:24915261.

    Article  PubMed  Google Scholar 

  28. Abbatini F, Capoccia D, Casella G, Soricelli E, Leonetti F, Basso N. Long-term remission of type 2 diabetes in morbidly obese patients after sleeve gastrectomy. Surg Obes Relat Dis. 2013;9(4):498–502. Epub 2012 Sep 18. PMID:23290187.

    Article  PubMed  Google Scholar 

  29. Arterburn DE, Bogart A, Sherwood NE, et al. A multisite study of long-term remission and relapse of type 2 diabetes mellitus following gastric bypass. Obes Surg. 2013;23(1):93–102. PMID: 23161525.

    Article  PubMed  Google Scholar 

  30. Caiazzo R, Arnalsteen L, Pigeyre M, et al. Long-term metabolic outcome and quality of life after laparoscopic adjustable gastric banding in obese patients with type 2 diabetes mellitus or impaired fasting glucose. Br J Surg. 2010;97(6):884–91. PMID:20473998.

    Article  CAS  PubMed  Google Scholar 

  31. Chikunguwo SM, Wolfe LG, Dodson P, et al. Analysis of factors associated with durable remission of diabetes after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2010;6(3):254–9. Epub 2009 Nov 10. PMID:20303324.

    Article  PubMed  Google Scholar 

  32. Cohen RV, Pinheiro JC, Schiavon CA, Salles JE, Wajchenberg BL, Cummings DE. Effects of gastric bypass surgery in patients with type 2 diabetes and only mild obesity. Diabetes Care. 2012;35(7):1420–8. PMID:22723580.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Cruz-Munoz N, Messiah SE, Arheart KL, Lopez-Mitnik G, Lipshultz SE, Livingstone A. Bariatric surgery significantly decreases the prevalence of type 2 diabetes mellitus and pre-diabetes among morbidly obese multiethnic adults: long-term results. J Am Coll Surg. 2011;212(4):505–11. PMID:21463779.

    Article  PubMed  Google Scholar 

  34. DePaula AL, Stival AR, DePaula CC, Halpern A, Vencio S. Surgical treatment of type 2 diabetes in patients with BMI below 35: mid-term outcomes of the laparoscopic ileal interposition associated with a sleeve gastrectomy in 202 consecutive cases. J Gastrointest Surg. 2012;16(5):967–76. Epub 2012 Feb 18. PMID:22350720.

    Article  PubMed  Google Scholar 

  35. DiGiorgi M, Rosen DJ, Choi JJ, et al. Re-emergence of diabetes after gastric bypass in patients with mid- to long-term follow-up. Surg Obes Relat Dis. 2010;6(3):249–53. Epub 2009 Oct 29. PMID:20510288.

    Article  PubMed  Google Scholar 

  36. Heneghan HM, Cetin D, Navaneethan SD, Orzech N, Brethauer SA, Schauer PR. Effects of bariatric surgery on diabetic nephropathy after 5 years of follow-up. Surg Obes Relat Dis. 2013;9(1):7–14. Epub 2012 Oct 12. PMID:23211651.

    Article  PubMed  Google Scholar 

  37. Kim S, Richards WO. Long-term follow-up of the metabolic profiles in obese patients with type 2 diabetes mellitus after Roux-en-Y gastric bypass. Ann Surg. 2010;251(6):1049–55. PMID:20485144.

    Article  PubMed  Google Scholar 

  38. Kota SK, Ugale S, Gupta N, et al. Ileal interposition with sleeve gastrectomy for treatment of type 2 diabetes mellitus. Indian J Endocrinol Meta. 2012;16(4):589–98. PMID:22837922.

    Article  CAS  Google Scholar 

  39. Lakdawala M, Shaikh S, Bandukwala S, Remedios C, Shah M, Bhasker AG. Roux-en-Y gastric bypass stands the test of time: 5-year results in low body mass index (30–35 kg/m2) Indian patients with type 2 diabetes mellitus. Surg Obes Relat Dis. 2013;9(3):370–8. Epub 2012 Aug 7. PMID:23068107.

    Article  PubMed  Google Scholar 

  40. Marinari GM, Papadia FS, Briatore L, Adami G, Scopinaro N. Type 2 diabetes and weight loss following biliopancreatic diversion for obesity. Obes Surg. 2006;16(11):1440–4. PMID:17132408.

    Article  PubMed  Google Scholar 

  41. Nora M, Guimaraes M, Almeida R, et al. Metabolic laparoscopic gastric bypass for obese patients with type 2 diabetes. Obes Surg. 2011;21(11):1643–9. PMID:21512818.

    Article  PubMed  Google Scholar 

  42. Sultan S, Gupta D, Parikh M, et al. Five-year outcomes of patients with type 2 diabetes who underwent laparoscopic adjustable gastric banding. Surg Obes Relat Dis. 2010;6(4):373–6. Epub 2010 Mar 1. PMID:20627708.

    Article  PubMed  Google Scholar 

  43. Todkar JS, Shah SS, Shah PS, Gangwani J. Long-term effects of laparoscopic sleeve gastrectomy in morbidly obese subjects with type 2 diabetes mellitus. Surg Obes Relat Dis. 2010;6(2):142–5. Epub 2009 Jul 10. PMID:19733513.

    Article  PubMed  Google Scholar 

  44. Yang JT, Li CX, Liu HM, Gu HG, Chen P, Liu BH. Effects of subtotal gastrectomy and Roux-en-Y gastrojejunostomy on the clinical outcome of type 2 diabetes mellitus. J Surg Res. 2010;164(1):e67–71. Epub 2010 Jul 30. PMID:20863527.

    Article  PubMed  Google Scholar 

  45. Johnson BL, Blackhurst DW, Latham BB, et al. Bariatric surgery is associated with a reduction in major macrovascular and microvascular complications in moderately to severely obese patients with type 2 diabetes mellitus. J Am Coll Surg. 2013;216(4):545–56. Epub 2013 Feb 5. PMID:23391591.

    Article  PubMed  Google Scholar 

  46. Romeo S, Maglio C, Burza MA, et al. Cardiovascular events after bariatric surgery in obese subjects with type 2 diabetes. Diabetes Care. 2012;35(12):2613–7. PMID:22855732.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  47. Pontiroli AE, Morabito A. Long-term prevention of mortality in morbid obesity through bariatric surgery. A systematic review and meta-analysis of trials performed with gastric banding and gastric bypass. Ann Surg. 2011;253(3):484–7. PMID:21245741.

    Article  PubMed  Google Scholar 

  48. Dimick JB, Welch HG, Birkmeyer JD. Surgical mortality as an indicator of hospital quality: the problem with small sample size. JAMA. 2004;292(7):847–51. PMID:15315999.

    Article  CAS  PubMed  Google Scholar 

  49. Sjöström L. Review of the key results from the Swedish Obese Subjects (SOS) trial—a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273(3):219–34. Epub 2013 Feb 8. PMID:23163728.

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank Xun Yao for his generous support in performing the database search. XS is supported by Young Investigator Award, Sichuan University (project no. 2013SCU04A37).

Author Contributions

JY conceived and designed this study, searched the literature, extracted data, synthesized data, and developed the first draft of the manuscript. XZ carefully checked studies and extracted data. LL contributed substantially to the update of the study and analyses. XS provided critical methodological guidance. All authors critically revised the manuscript

Conflict of Interest

Authors reported no potential conflicts of interest

Author information

Authors and Affiliations

  1. Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China

    Jiajie Yu, Xu Zhou & Jing Tan

  2. West China Medical School, Sichuan University, Chengdu, China

    Jiajie Yu

  3. Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China

    Sheyu Li

  4. Chinese Evidence-based Medicine Center, Clinical Research and Evaluation Unit, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, China

    Ling Li, Youping Li & Xin Sun

Authors
  1. Jiajie Yu
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  2. Xu Zhou
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  3. Ling Li
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  4. Sheyu Li
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  6. Youping Li
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Corresponding authors

Correspondence to Youping Li or Xin Sun.

Appendices

Appendix 1: Search Strategy

PubMed:

#1 “Bariatric Surgery” [Mesh]

#2 “Biliopancreatic Diversion” [Mesh]

#3 “Gastrectomy” [Mesh]

#4 Bariatric Surger*[tw]

#5 obesity surger*[tw]

#6 metabolic surger*[tw]

#7 Gastric Bypass*[tw]

#8 stomach bypass*[tw]

#9 gastric banding*[tw]

#10 gastric band [tw] or gastric bands [tw]

#11 Gastroplast*[tw]

#12 “Gastrectomy” [Mesh]

#13 gastrectom*[tw]

#14 “Biliopancreatic Diversion” [Mesh]

#15 Biliopancreatic Diversion*[tw]

#16 Biliopancreatic Bypass*[tw]

#17 Bilio pancreatic Diversion*[tw]

#18 Bilio pancreatic Bypass*[tw]

#19 1 OR 2 OR 3 OR 4 OR 5 OR 6 OR 7 OR 8 OR 9 OR 10 OR 11 OR 12 OR 13 OR 14 OR No. 15 OR 16 OR 17 OR 18

#20 Randomized controlled trial [pt]

#21 Controlled clinical trial [pt]

#22 Randomized [tiab]

#23 Placebo [tiab]

#24 Clinical trials as topic [Mesh]

#25 randomly [tiab]

#26 Trials [ti]

#27 “case-control studies” [Mesh]

#28 “Cohort studies” [Mesh]

#29 “Longitudinal studies” [Mesh]

#30 “retrospective studies” [Mesh]

#31 “Follow-Up Studies” [Mesh]

#32 “prospective studies” [Mesh]

#33 Cohort analys*[ti,ab]

#34 Cohort stud*[ti,ab]

#35 Follow-up stud*[ti,ab]

#36 Follow-up stud*[ti,ab]

#37 Follow-up stud*[ti,ab]

#38 Longitudinal stud*[ti,ab]

#39 Longitudinal survey*[ti,ab]

#40 Prospective stud*[ti,ab]

#41 Retrospective stud*[ti,ab]

#42 incidence stud*[ti,ab]

#43 concurrent stud*[ti,ab]

#44 comparison group*[ti,ab]

#45 nonrandom*[ti,ab]

#46 control group*[ti,ab]

#47 database*[ti,ab]

#48 population*[ti,ab]

#49 "Registries"[Mesh]

#50 registr*[ti,ab]

# 51 case-control stud*[ti,ab]

#52 20 OR 21 OR 22 OR 23 OR 24 OR 25 OR 26 OR 27 OR 28 OR 29 OR 30 OR 31 OR 32 OR 33 OR 34 OR 35 OR 36 OR 37 OR 38 OR 39 OR 40 OR 41 OR 42 OR 43 OR 44 OR 45 OR 46 OR 47 OR 48 OR 49 OR 50 OR 51

#53 19 AND 52

#54 animals [mh] NOT humans [mh]

#55 and 53 NOT 54

EMbase (OVID)

1 exp bariatric surgery/

2 exp biliopancreatic diversion/

3 exp Gastrectomy/

4 exp sleeve gastrectomy/

5 bariatric surger*.af.

6 metabolic surger*.af.

7 obesity surger*.af.

8 gastric bypass*.af.

9 stomach bypass*.ti, ab.

10 Jejunoileal Bypass*.af.

11 Biliopancreatic Bypass*.af.

12 Bilio pancreatic Bypass*.af.

13 BilioPancreatic Diversion*.af.

14 Bilio Pancreatic Diversion*.af.

15 Gastrectom*.af.

16 Gastric banding*.af.

17 Gastric band or gastric bands.af.

18 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17

19 (clinical trial or controlled clinical trial or randomized controlled trial).pt.

20 Clinical trials as topic/ or controlled clinical trials as topic/ or randomized controlled trials as topic/

21 Random*.ti,ab.

22 Clinical trial*.ti,ab.

23 Controlled trial*.ti,ab.

24 Case-control studies/

25 Retrospective studies/

26 Cohort studies/

27 Longitudinal studies/

28 Follow-up studies/

29 Prospective studies/

30 Cohort.ti,ab.

31 Longitudinal.ti,ab.

32 Follow-up.ti,ab.

33 Follow-up.ti,ab.

34 Prospective*.ti,ab.

35 Retrospective*.ti,ab.

36 Non-random*.ti,ab.

37 Comparison group*.ti,ab.

38 Control group*.ti,ab.

39 Database*.ti,ab.

40 Population*.ti,ab.

41 registries/

42 Registr*.ti,ab.

43 Case-control stud*.ti,ab

44 19 or 20 or 21 or 22 or 23 or 24 or 25 or 26 or 27 or 28 or 29 or 30 or 31 or 32 or 33 or 34 or 35 or 36 or 37 or 38 or 39 or 40 or 41 or 42 or 43

45 18 and 44

46 Limit 45 to humans

CENTRAL

1 exp bariatric surgery/

2 exp biliopancreatic diversion/

3 exp Gastrectomy/

4 exp sleeve gastrectomy/

5 bariatric surger*.af.

6 metabolic surger*.af.

7 obesity surger*.af.

8 gastric bypass*.af.

9 stomach bypass*.ti, ab.

10 Jejunoileal Bypass*.af.

11 Biliopancreatic Bypass*.af.

12 Bilio pancreatic Bypass*.af.

13 BilioPancreatic Diversion*.af.

14 Bilio Pancreatic Diversion*.af.

15 gastrectom*.af.

16 gastric banding*.af.

17 gastric band or gastric bands.af.

18 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17

Appendix 2: Assessment of the Risk of Bias

Table 7 Risk of bias of randomized controlled trial
Full size table
Table 8 Risk of bias of cohort studies (with control)
Full size table
Table 9 Risk of bias of cohort studies (without control)
Full size table

Appendix 3

Table 10 Adverse events following bariatric surgery
Full size table

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Yu, J., Zhou, X., Li, L. et al. The Long-Term Effects of Bariatric Surgery for Type 2 Diabetes: Systematic Review and Meta-analysis of Randomized and Non-randomized Evidence. OBES SURG 25, 143–158 (2015). https://doi.org/10.1007/s11695-014-1460-2

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